Early detection of cervical cancer increased after ACA expanded coverage

The Affordable Care Act may have helped more women get early treatment for cervical cancer, according to a preliminary new study.

The fraction of young women whose cervical cancers were found and treated early -- when women have a better chance of survival -- increased after 2010, when the ACA expanded insurance coverage to young people by allowing them to remain on their parents' health plans.

Before the 2010 insurance expansion, 71% of cervical cancers in women ages 21 to 25 were found early, at stage 1 or 2, according to the study, published Tuesday in JAMA. That percentage increased to 79% after the expansion.

More women were also eligible for less aggressive treatments after the insurance change took effect, the study said.

The percentage of women in this age group who were eligible for less aggressive treatments -- which usually allow them to have children in the future -- also increased, rising from 26% of cervical cancer patients before the coverage change to 39% after, according to the study.

When cervical cancer is caught early, doctors can treat it with relatively small surgeries that leave the uterus intact, so that women can still have children, said Xuesong Han, director of surveillance and health services research at the American Cancer Society, which led the study. Cervical cancers that are diagnosed at an advanced stages require much more aggressive treatment; women may need a hysterectomy, as well as radiation and chemotherapy, Han said.

"Cervical cancer is a young woman's disease," said Kevin Ault, a professor at the University of Kansas Medical Center. "Finding this cancer earlier will give women more choices of treatment."

Early detection can also save lives from cervical cancer. While 91% of women with early cervical cancer survive at least five years, only 16% of those with advanced disease live that long, according to the American Cancer Society.

The number of cervical cancers has fallen sharply in recent decades, thanks largely to screening. In the 1930s and 1940s, cervical cancer was the leading cause of cancer-related death in women, Ault said. Today, the disease affects 12,900 American women a year and kills about 4,100, according to the cancer society.

"Cervical cancer is nearly 100% preventable," Ault said. Women have two ways to protect themselves. First, they can get regular screenings, which allow doctors to detect and remove pre-cancerous lesions, Ault said. The American College of Obstetricians and Gynecologists recommends women receive cervical cancer screening beginning at age 21.

Women also can protect themselves by receiving a vaccine that prevents infection with HPV, the human papillomavirus, the virus that causes most cervical cancers. The Centers for Disease Control and Prevention recommends giving the HPV vaccine to girls at age 11 or 12, because the shot is most effective when administered before people become sexually active.

The Obama administration has credited the ACA with increasing coverage to 3 million additional young adults. Others have pegged the number who gained insurance at 930,000.

Women with insurance coverage were more likely to have their cancers detected early, according to the new study. About 78% of those with private insurance had their cancers treated early, compared to 67% of women without insurance and 65% of those with Medicaid coverage.

A study like this can't prove cause and effect. There's no way to definitively prove that it was the ACA -- and not some other factor -- that led to women getting earlier care for cancer. But researchers found evidence that supports the notion that the ACA should get credit: there was no significant increase in the percentage of cervical cancers found eraly among women ages 26 to 34, who weren't eligible for the 2010 insurance expansion.